Race, Psychosocial Factors Predict Negative HbA1c Trajectories in Youth with Type 1 Diabetes

MEMPHIS, TN— Psychosocial factors, such as how peer relationships impact diabetes management in social scenarios, are a key part of understanding racial inequities in high hemoglobin A1c (HbA1c) trajectories in youth with Type 1 diabetes, according to research from Le Bonheur Children’s Hospital and the University of Tennessee Health Science Chief of Pediatric Endocrinology Ramin Alemzadeh, MD, and Psychologist Angelica R. Eddington, PhD, published in the Journal of Pediatric Psychology.

“Psychosocial factors are so central that, without addressing them, other medical diabetes interventions are unlikely to be successful,” said Alemzadeh. “From a clinical standpoint, it is important to consider youth who anticipate trouble adhering to treatment in social situations when forming a treatment plan.”

The study was led by Principal Investigator Mary E. Keenan, MS, using data from the University of Memphis Predicting Resilience in Youth with DiabetEs (PRYDE) study which was led by Principal Investigator Kristoffer S. Berlin, PhD. The aim of this research was to expand the literature that speaks to health disparities in glycemic control of black adolescents based on factors that might contribute to these disparities – particularly social information processing (SIP) variables. Adolescents who disagreed with statements about diabetes care such as “I’d think my friends would understand” or “I think I would be likely to do my diabetes care in this situation” was a predictor of poor HbA1c trajectories.

Youth were divided into three groups based on the trajectory of HbA1c in the study – high decelerating, mid-high accelerating and near-optimal accelerating. Results showed that black participants were highly likely to be in the high decelerating and mid-high accelerating groups. Anticipated adherence difficulties (AAD) to treatment in social situations and other stress associated with diabetes management were also predictors of being in these groups. These results shine a light on the need to focus on the unique psychosocial factors and stress in social interactions faced by youth with Type 1 diabetes in communities of color in order to improve HbA1c trajectory.

“Previous studies have been carried out in predominantly white samples,” said Keenan, “But we know that black youth have distinct social experiences that impact diabetes care adherence, including institutional and individual instances of racism.”

Previous studies have also shown that racial and ethnic minorities experience significant disparities in achieving recommended HbA1c levels. But health care related factors such as barriers to care and access to diabetes technology such as insulin pumps do not account for the entirety of that disparity. Psychosocial factors are another vital component of diabetes management especially when they cause youth to forego diabetes care in public to avoid negative judgments from peers.

The study followed 184 youth between 12 and 18 years with Type 1 diabetes receiving treatment at Le Bonheur Children’s. Fifty-seven percent of participants were black. Youth and caregivers completed questionnaire packets at baseline and approximately six and 12 months later to analyze psychosocial factors of diabetes management. The questionnaire consisted of the Attributions of Peer Reactions Scale Short Form (APR-SF) which describes various situations youth would need to take insulin around peers and allowed youth to choose how they would likely respond, and the Diabetes Stress Questionnaire (DSQ), a 65-item self-report measure covering various stressors including parental stress, peer stress, adverse-personal effects and more. HbA1c values were also gathered at the same three time points.

“For black youth, addressing stressors at multiple levels of their social systems could be an important avenue for future intervention, especially contextualized within the minority stress model,” said Eddington. “Further research should consider the intersecting identities of youth with Type 1 diabetes and the multiple sociocultural levels at which they interact with their world.”


About Le Bonheur Children’s:

Le Bonheur Children’s Hospital in Memphis, Tenn., treats children through community programs, regional clinics and a 255-bed state-of-the-art hospital. Le Bonheur serves as a primary teaching affiliate for the University Tennessee Health Science Center and trains more than 350 pediatricians and specialists each year. Nationally recognized, Le Bonheur is ranked by U.S. News & World Report as a Best Children’s Hospital. 

For more information, please call (901) 287-6030 or visit lebonheur.org. Connect with us at facebook.com/lebonheurchildrens, twitter.com/lebonheurchild or on Instagram at  lebonheurchildrens.


About the University of Tennessee Health Science Center:

As Tennessee’s only public, statewide, academic health system, the mission of the University of Tennessee Health Science Center is to bring the benefits of the health sciences to the achievement and maintenance of human health through education, research, clinical care, and public service, with a focus on the citizens of Tennessee and the region. The main campus in Memphis includes six colleges: Dentistry, Graduate Health Sciences, Health Professions, Medicine, Nursing and Pharmacy. UTHSC also educates and trains medicine, pharmacy, and/or health professions students, as well as medical residents and fellows, at major sites in Knoxville, Chattanooga and Nashville. For more information, visit www.uthsc.edu. Find us on Facebook: facebook.com/uthsc, on Twitter: twitter.com/uthsc and on Instagram: instagram.com/uthsc


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Posted: 6/7/21

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